Obesity and alcohol responsible for nearly 30,000 cases of breast cancers in the next decade

Maintaining a healthy weight and not consuming alcohol regularly could help prevent thousands of breast cancer cases, a new big data study by researchers has found. The findings could help inform future cancer control strategies.

The large collaborative study was published recently. It pooled six Australian cohort studies including over 200,000 women and evaluated what proportion of pre-menopausal and post-menopausal breast cancers could be prevented by modifying current behaviours.

“We found that current levels of overweight and obesity are responsible for the largest proportion of preventable future breast cancers – more specifically, 17,500 or 13% of breast cancers in the next decade,” says study author and a Dr.

“Regular alcohol consumption is the second largest contributor – 13% of pre-menopausal and 6% of post-menopausal breast cancers, that is 11,600 cases over the next 10 years, are attributable to consuming alcohol regularly.”

This was the first time that regular alcohol consumption was shown as the leading modifiable cause of breast cancer burden for pre-menopausal women.

Although the current Australian recommendation is to not drink more than two alcoholic drinks per day on average, the study found that risk of breast cancer increased with an average consumption of just one alcoholic drink per day.

More than half of Australian women currently report drinking alcohol regularly, and three in five Australian women are overweight or obese.

The researchers also found current use of menopausal hormone therapy (MHT) to explain 7% of postmenopausal breast cancers, with over 90% of this burden explained by a long-term use of at least 5 years. Similarly, the researchers found current long-term use of oral contraceptives to explain 7% of
premenopausal breast cancers.

“Our findings support the current Australian and international recommendations of using MHT for the shortest duration possible, and only to alleviate menopausal symptoms, not for the prevention of chronic disease,” Dr. says.

“When it comes to oral contraception, it is not recommended that women restrict their use of OCs – the latest position statement from Cancer Council says that over the course of a woman’s lifetime, the net effect of OCs is actually cancer-protective, as they provide long-term protection against endometrial and ovarian cancers, meaning that the potential benefits, including reproductive benefits, outweigh the harms.”

Jointly, these behavioural and hormonal factors explain about one in five breast cancers, amounting to 37,000 breast cancers over the next 10 years.

For the first time, the researchers were able to compare the breast cancer burden for different population subgroups. They identified population subgroups with the greatest burden of preventable
post-menopausal breast cancer.

“For instance, we found that the body fatness-related burden is greatest (20%) among those with lower educational attainment, and the MHT-related burden is greatest (10%) among those of healthy weight, those consuming alcohol more frequently and those of higher socioeconomic status,” Dr.
says.
The findings may help to target preventative measures to high-burden subgroups that are likely to benefit most.

Breast cancer is the most common cancer in women in Australia and worldwide – in 2018, an estimated 18,000 Australian women were diagnosed with breast cancer. It is also the second leading cause of cancer death in Australian women.

“That means that consequently, even relatively small preventable proportions translate into large numbers of preventable breast cancers,” the Dr. says.

“If confirmed, these findings are likely to contribute important evidence for individual and populationlevel cancer control strategies,” the Dr. concludes.

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Study links severe hot flashes to sleep disorder risk in women

A recent study has said that severe hot flashes in midlife may increase the risk of sleep disorder in women. 

According to researchers, early diagnosis of sleep disorder is important to control risk of heart disease, stroke, depression and death. Obstructive Sleep Apnea (OSA), which is more common in men than women, occurs more frequently as women age, gain weight and reach perimenopause and postmenopause stage.

Up to 80 percent of women in midlife experience hot flashes or night sweats. The findings indicated that perimenopausal and postmenopausal women who experienced disturbed sleep showed that 53 percent had a sleep disorder such as OSA, restless leg syndrome, or both.

The diagnosis of OSA in women can be more challenging because their symptoms are different from the more obvious ones that men experience, such as loud snoring. Symptoms for women include insomnia, headaches, fatigue, depression and anxiety.

The identification of OSA is important because it is associated with a significantly increased risk of heart disease, hypertension, stroke, depression and death. For the study, 1,691 women  completed questionnaires.

Of these women, 24.9 percent were classified in the intermediate and high-risk categories for OSA. These women were likely to be older and have a higher body mass index with greater incidence of hypertension.

Women reporting severe hot flashes in midlife were at a higher risk for OSA--1.87 times higher than in women with mild or no hot flashes. "Sleep disruption is a common complaint at menopause. It is important to recognise the high number of un-diagnosed sleep disorders, including OSA," said study author.

Early morning headaches or excessive daytime sleepiness should raise concern for OSA and signal a possible need for sleep apnea testing, the author explained.

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Hot flashes may predict the risk of heart disease in pre-menopausal women

Hot flashes in women at the pre-menopausal stages may signal emerging vascular dysfunction that can lead to heart disease, claims a new study.

Hot flashes — a sudden feeling of feverish heat, typically as a symptom of menopause — have already been shown to interfere with a woman’s overall quality of life.

The condition is reported by 70% of women, with approximately one-third of them describing them as frequent or severe. 

“Hot flashes are not just a nuisance. They have been linked to cardiovascular, bone, and brain health,” said JoAnn Pinkerton, Executive Director of North American Menopause Society — a US-based nonprofit organisation. 

The findings, published in the journal Menopause, showed that hot flashes, linked to cardiovascular changes, occur early during the menopause transition.

Newer data indicate that hot flashes often start earlier than previously thought — possibly during the late reproductive years — and persist for a decade or more, the researchers said.

For the study, the team involved 272 non-smoking women aged 40 to 60 years to test the relationship between physiologically assessed hot flashes and endothelial cell (the inner lining of the blood vessels) function. 

The effect of hot flashes on the ability of blood vessels to dilate was documented only in the younger fertile of women in the sample.
There was no association observed in the older women (age 54-60 years), indicating that early occurring hot flashes may be those most relevant to heart disease risk. 

“Physiologically assessed hot flashes and endothelial function among midlife women,” may offer valuable information for healthcare providers working to assess the risk of heart disease in their menopausal patients, Pinkerton said.

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Why migraine worsens in women approaching menopause

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 The risk of headache was most apparent during the later stage of the perimenopause, which is a time during which women first begin skipping menstrual periods and experience low levels of estrogen, the study revealed.
"The risk for high frequency headache, or more than 10 days with headache per month, increased by 60 percent in middle-aged women with migraine during the perimenopause, the transitional period into menopause marked by irregular menstrual cycles, as compared to normally cycling women," said lead author Vincent Martin, professor at University Of Cincinnati in Ohio, US.
The menopausal years include both the pre-menopause and menopause. Menopause begins when women have not had a menstrual period for one year. Symptoms such as hot flashes, irritability, depression and insomnia are common during both.

 "Changes in female hormones such as estrogen and progesterone that occur during the perimenopause might trigger increased headaches during this time," noted Richard Lipton, professor at Albert Einstein College of Medicine in US.


Women who participated in the study also reported that high frequency headache increased by 76 percent during menopause, the findings showed. Researchers identified the group of 3,664 women aged 35 to 65 who experienced migraine before and during their menopausal years.

Women with migraine were asked to self-report their frequency of headaches as well as the characteristics of their menstrual cycles.

Based on the characteristics of their menstrual cycles they were placed into one of three groups: pre-menopause (normally cycling), perimenopause (irregularly cycling) and menopause (no cycling). Researchers suggested hormonal therapies for women approaching menopause and suffering from migraine.

The findings were published online this week in Headache: The Journal of Head and Face Pain, a publication of the American Headache Society.